What I Do

Building On The Affordable Care Act

August 1, 2012

The U.S. Supreme Court’s decision upholding the constitutionality of the Affordable Care Act (ACA) is only the beginning of the next phase of health care reform. The path forward should be clear: First, we must move full speed ahead to implement the ACA; second, we must firmly reject efforts to undo the progress that already has been made with the ACA, Medicaid and Medicare; and third, we must build upon the ACA, Medicaid and Medicare to achieve our goal of quality health care for all.

Now that the ACA has been ruled constitutional, states should act without delay to assure that 33 million Americans will be able to obtain health care coverage through the Medicaid program and new health insurance exchanges beginning in 2014.

All states should implement the expansion of Medicaid to cover people with incomes below 138 percent of the federal poverty level. It would be immoral and politically foolish for governors to refuse this expansion of coverage to the uninsured, which is 100 percent federally funded in the first three years and 93 percent federally funded over the first decade, and which would reduce state spending for the uninsured.

States have until Nov. 16, 2012, to submit to the Centers for Medicare and Medicaid Services their applications to operate new health insurance exchanges under the ACA. Whether states choose to operate exchanges on their own or in partnership with the federal government, they should move forward without delay.

For its part, the federal government should insist that exchanges operate with high standards of quality and cost-effectiveness and not become captives of the large insurance companies. Implementation of the ACA, including the exchanges, must strengthen rather than threaten employment-based plans, such as multiemployer funds, that already operate under such high standards. Employment-based coverage could be in imminent danger if the exchanges are structured without safeguarding these funds.

Because the ACA will extend health care coverage to as many as 33 million more Americans, implementation of the Act must ensure that there are enough health care professionals—including doctors, nurses, paraprofessionals, and direct care workers—where they are most needed. Education and professional training are essential to meet this increased demand. The ACA provides resources to expand the workforce of primary care providers, shift care into community settings, and create a National Health Care Workforce Commission, and it is critical that Congress fully fund these efforts. What should be clear by now is that the ACA is here to stay, and the process of health care reform must continue moving forward, not backward. We call on Republicans in Congress to stop wasting everyone’s time trying to repeal or defund the ACA. The ACA was enacted for a reason: because our health care system was broken. A return to the way things were before the ACA was enacted is simply not an option.

Although Republicans have attacked “Obamacare” relentlessly, there is overwhelming public support for the many ways in which the ACA improves our health care system. Because of the ACA, seniors will save money on prescription drugs as the Part D donut hole is closed over the next eight years. Insurance companies no longer will be able to deny coverage due to pre-existing conditions, charge women more or drop coverage for those who get sick. Six million young adults will continue being covered by their parents’ health plan. The ACA sets limits on the amount of money that insurers can spend on their own profits, salaries and marketing, which already has resulted in rebates of $1.1 billion to businesses and families who were overcharged. And the ACA guarantees no-cost preventive care, from which 86 million people already have benefited.

The ACA is a historic achievement in which President Obama and Democrats in Congress can and should take enormous pride. The moral high ground belongs to those who have fought and continue fighting to make our health care system better for ordinary Americans, not to those who would undo the improvements, increase costs for consumers, increase the number of people without health care and even increase the deficit in the process.

Proposals by Republican presidential candidate and former Gov. Mitt Romney (Mass.) and other Republicans to “block grant” Medicaid would similarly undo much of the progress America already has made through this program, as well. The Romney proposal would cap Medicaid spending with a block grant that cuts $200 billion per year. Block granting proposals are premised on the assumption that Medicaid is wasteful or inefficient, but the fact is that Medicaid costs 20 percent less than private insurance for adults and 27 percent less than private insurance for children. Block granting proposals would bankrupt families who rely on Medicaid for long-term care and lead to millions more uninsured people. We also call on Congress to protect the integrity of Medicaid by ensuring that inherently governmental functions, such as determining beneficiary eligibility, are not privatized.

The union movement will reject and defeat Republican proposals to replace guaranteed Medicare benefits with a flat payment of “premium support”—also known as a voucher—which effectively would end Medicare as we know it. These proposals would hand Medicare over to private insurance companies, which, according to the Congressional Budget Office, have 30 percent higher costs than traditional Medicare for the same benefits. Premium support proposals would cripple the ability of Medicare to contain health care cost growth; increase overall health care costs, shift costs to seniors and increase their out-of-pocket spending; create a two-tier health care system; make Medicare’s risk pool more expensive to cover; and ultimately leave Medicare to “wither on the vine.”

America’s unions also will oppose proposals that would shift costs to Medicare beneficiaries in other ways—whether by increasing their premiums, charging higher co-pays, placing a tax on supplemental coverage or raising the Medicare eligibility age. Such proposals would do nothing to fix the inefficiencies of the health care system, but simply would impose burdensome new expenses on households of modest means.

Controlling the growth of health care costs must be a top priority. Unless health care costs are brought under control, they are projected to bankrupt individuals, families, businesses, and governments by the latter half of the 21st century. If we want to advance along the path to a more equitable and cost-effective health care system, we have no choice but to build on the achievements of the ACA, Medicaid and Medicare.

The ACA is our first step toward expanding health care coverage, improving care and beginning to get control over health care costs. One essential next step is to build on the payment and delivery reforms of the ACA in order to improve Medicare.

Medicare has proven to be more cost effective than private health insurance plans over the past four decades. We need to take advantage of the market power of Medicare to extend payment and delivery reforms throughout the entire U.S. health care system. A simple, indisputably constitutional solution would be to allow employers and Americans of all ages to buy into an improved Medicare program. And we know from the experience of other industrialized countries that Medicare for all would be the most effective way to contain health care cost growth and achieve quality health care for everyone. To succeed in holding down costs without sacrificing care, we continue to believe the social insurance model must be our goal, and we applaud Senator Sanders and Representatives McDermott, Conyers, Stark, and Dingell for having introduced bills that would take us in that direction.

What should be crystal clear, however, is that we cannot afford to go backward, which is where Romney and the Republican leadership in Congress would take us. Their prescriptions would not expand coverage or control health care costs, but rather would shift costs to working families, retirees and the states. Shifting more and more costs onto the backs of consumers does nothing to contain overall costs and is no solution at all.

America’s union movement will not take our eyes off the prize. We will keep moving forward until the right to a single high standard of health care is a reality for everyone in America.